Lactation Interrupted: PFAS Impact on Capacity to Breastfeed Ignored

Purpose of Review In this commentary, we focus on the association between exposure to per-and polyfluoroalkyl substances (PFAS) and effects on breastfeeding duration and mammary gland function. We argue that the ability to breastfeed is vulnerable to PFAS exposure and question whether recent regulatory and clinical decision-making contexts have adequately acknowledged these important public health impacts. Recent Findings Across geographically and sociodemographically distinct human populations, shorter duration of breastfeeding is apparent among those with the highest levels of circulating PFAS during pregnancy. Further, toxicological studies indicate that the mammary gland is one of the most sensitive tissues to disruption from PFAS exposure. However, recent analyses, such as the human health toxicity assessment supporting the national primary drinking water regulations and clinical monitoring recommendations fail to adequately incorporate these data into regulatory and clinical decisions that should also support new mothers and their infants. Summary To be more protective of public health, we recommend that mammary gland functional effects, including breastfeeding duration, be incorporated in future risk assessment, regulatory, and clinical decision-making contexts. Future toxicological research, including routine toxicological testing, should use contemporary measures of mammary gland development and function to more fully evaluate the impacts on mammary gland function after exposure to a wider variety of PFAS beyond perfluorooctanoic acid (PFOA). In addition, clinical recommendations regarding breastfeeding should acknowledge and address the unique concerns expressed by PFAS-exposed individuals and communities.